Enter details below to order your Ice-Art sculpture NB. East Coast Australia only YOUR INFORMATION Name: Billing Address: Company: Phone / Work: Phone/Home: Fax: Mobile: E-mail: DELIVERY INFORMATION Contact Name: Delivery Address: Suburb:   Date of Delivery: Time of Delivery:  Time Guests due: Freezer available?:  Select YES NO Type of event?: Special requirements?: PURCHASE ORDER # ICE-ART SCULPTURES Sculptures Colour Price incl. GST   Freight $   TOTAL $   PAYMENT METHOD We offer several payment options; we can bill your Credit Card, you can fax your details to us, you can post us a money order or cheque, or we can call you to receive your credit card numbers via the phone. Payment Type Please Select Credit Card Phone me Money Order / cheque Fax Order Bartercard Card Name Card Type Please Select Mastercard American Express Bank Card Visa Card Bartercard Card Number Exp Date Additional Comments:

or Post Cheque or Money Order to:
PO BOX 273
ANNERLEY BRISBANE 4103 AUSTRALIA